Knowledge and Practice of Breast Self-Examination Among Female Nursing Students in University of Maiduguri, Borno State, Nigeria

International Journal of Clinical Oncology and Cancer Research 2017; 2(3): 57-64 http://www.sciencepublishinggroup.com/j/ijcocr doi: 10.11648/j.ijcocr.20170203.12 Knowledge and Practice of Breast Self-Examination Among Female Nursing Students in University of Maiduguri, Borno State, Nigeria Habu Haruna 1, Emmanuel Okechukwu Chukwu 2, *, Inuwa Ahmadu 1, Kever Robert Teryila 1, Maigari Babaji 1, Lola Nelson 1, Dathini Hamina 1 1 Department of Nursing Science, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria 2 School of Nursing Mkar, Gboko, Nigeria Email address: emmanwaguy42@yahoo.com (E. O. Chukwu) * Corresponding author To cite this article: Habu Haruna, Emmanuel Okechukwu Chukwu, Inuwa Ahmadu, Kever Robert Teryila, Maigari Babaji, Lola Nelson, Dathini Hamina. Knowledge and Practice of Breast Self-Examination Among Female Nursing Students in University of Maiduguri, Borno State, Nigeria. International Journal of Clinical Oncology and Cancer Research. Vol. 2, No. 3, 2017, pp. 57-64. doi: 10.11648/j.ijcocr.20170203.12 Received: March 30, 2017; Accepted: April 25, 2017; Published: June 20, 2017 Abstract: Breast cancer appears to be a disease of both developing and developed nations; it is the leading cause of death universally and responsible for about 12% of death throughout the world. The risk of breast cancer increases with age. The primary factor that increases breast cancer in women includes certain genetic mutations, personal family history of breast cancer and biopsy confirming hyperplasia. The purpose of breast self-examination is to learn the topography of the breast which will allow one to notice changes in the breast such as breast lumps or masses. Breast self-examination is done monthly between the 7 th and 10 th day of menstrual cycle which is early identification of abnormality and is also a low risk procedure that do not cause pain or discomfort. The aim of the study is to evaluate the knowledge and practice of female students in relation to breast self-examination. A non-experimental descriptive study was used to examined the knowledge and practice of breast self-examination among female nursing students of the department of nursing science, university of Maiduguri. A selfstructured questionnaire with a content validity and reliability of 0.82 and 0.78 respectively. Using Yemen s formula, sample size of one hundred and nine (109) respondents were selected from 100 level to 500 level nursing students using simple random sampling technique after the use of stratified random sampling which ensured that each strata (class level) was represented in the study. All data were analyzed using frequency and percentages and presented in tables. Chi-square statistic with 0.05 level of significant was used in testing the developed hypothesis. The findings shows that the majority of the students have knowledge on breast self-examination and they also practice breast self-examination. All hypotheses tested showed that there is significant relationship between knowledge, source of information, age and practice of breast self-examination as all the calculated values were greater than the critical value (table value). The researchers recommend that effort should be sustained in ensuring nursing students continue to update their knowledge and skills of breast self-examination and also educate their colleagues who have poor knowledge of BSE with the view to improving their practice. Keywords: Knowledge, Practice, Breast, Self-Examination, Female, Nursing Students 1. Introduction Medical advances have shown that one third of all cancers are preventable and a further one third if diagnosed sufficiently early is potentially curable (Gwarzo, Sabitu and Idris, 2009). Breast cancer is a global health issue and a leading cause of death among women internationally (Kathmadu 2008). It is responsible for about 12% of death throughout the world (Saadeldin et al, 2013). Breast cancer is distinguished from other types of cancer by the fact that it occurs in a visible organ and can be detected and treated at an early stage. This observation demands that breast cancer control should be of increasing priority in health care programme of developing countries like Nigeria. Breast self- examination is a risk free and painless

58 Habu Haruna et al.: Knowledge and Practice of Breast Self-Examination Among Female Nursing Students in University of Maiduguri, Borno State, Nigeria procedure conducted with the objectives of identifying breast related disorders and cancerous condition. A number of women perform this examination themselves as a screen test for breast cancer. Breast and region around it for lumps, distortions and swellings that might be an indication of breast related disorder or even breast cancer. The purpose of breast-self-examination is to learn the topography of the breast which will in turn allow one to notice changes in future in order to detect breast lumps or masses. Breast self-examination carried out once monthly, between the 7 th and 10 th day of the menstrual cycle, go a long way in detecting breast cancer at an early stage of growth when there is low risk of spread, ensuring a better prognosis when treated (Tasci and Usta, 2010). Early diagnosis usually results in treatment before metastasis and signifies a better outcome of management (Okobia, et al, 2006). Performing breast self-exams can help you find breast cancer and detect changes in your breasts early, when they re more likely to be treated successfully. Although not every cancer can be found by regularly examining your breasts, it is an important way to take care of yourself and lower your risk of breast cancer, especially combined with regular physical exams and mammograms (Mary, 2015). When the level of knowledge and practice of breast selfexamination among students of nursing science university of Maiduguri is ascertain, the department of nursing science will use the findings of the study to organize effective programmes that will improve the knowledge of the students and motivate them to practice breast self-examination. Therefore, assessing the knowledge and practice of breast self-examination and the factors affecting breast selfexamination among female students is the focus of the study. 1.1. Statement of the Problem Breast cancer is global health issue and a leading cause of death among women internationally. It is responsible for about 12% of death throughout the world (Philip, Harris, and Flaberty 2010). One or two in every twenty five Nigerian women are at risk of breast cancer, but higher risk exists for women who are older than forty five years, than thirty years at birth (WHO 2011). Studies have shown that many female do not carry out breast self-examination. Several reasons like lack of time, lack of self confidence in their ability to perform the techniques correctly, fear of possible findings or discovery of a lump and embarrassment associated with manipulation of the breast have been cited as reasons for not practicing breast self-examination Okobia et al (2006). According to Adesunkanmi, Lawal and Adelusola (2006) about 26% of the respondents do not practice breast selfexamination due to forgetfulness 21% do not practice it due to stress while 19% do not practice it due to lack of skills in performing breast self-examination. Rosemary et al (2011), stated that 34% do not practice breast self-examination due to lack of time 20% identified that they do not practice breast self-examination for fear of possible findings or discovery of a lump and 13.2% stated that reason why they don t practice breast self-examination for the embarrassment associated with manipulation of the breast. A study in Zaria revealed that 57% of the respondents do not practice breast selfexamination due to forgetfulness, 13% said it is because of lack of time and 8% believe that there is no problem with their breast. About 20% of the time, breast cancers are found by physical examination rather than by mammography. We recommend that all women routinely perform breast selfexams as part of their overall breast cancer screening strategy (Breastcancer.org, 2016). Also, breast cancer among younger women tends to be more severe, at a more advanced stage and more aggressive that those affecting older women (Gurdal et al, 2012). Young women aged 20-29 with breast cancer have a 72.4 percent mortality rate (Donmez, Dolgun and Yavuz, 2012). Breast self-examination knowledge and practice is of paramount importance in early detection of signs of breast abnormality hence earlier identification of breast cancer. Breast cancer is the principal cause of cancer deaths among women in Nigeria (Gucuk and Uyeturk, 2013; Gwarzo, Sabitu and Idris 2009). In Nigeria, most of the diagnoses of breast cancer are made when it is too late, thereby leading to several needless and painful deaths of our beloved ones (Owoaje and Balogun, 2005). 1.2. Objectives of the Study The main objective of the study is to assess the level of knowledge and practice of breast self-examination among female students of the department of nursing science, university of Maiduguri. This will be achieved through the following; 1. To determine the knowledge of breast self-examination among students of nursing department 2. To determine the practice of breast self-examination among female students of nursing department. 3. To identify factors that affect breast self-examination among female nursing students in nursing department. 1.3. Hypotheses The null hypothesis include 1. There is no significant relationship between knowledge and practice of breast self-examination. 2. There is no significant relationship between source of information and practice of breast self-examination. 3. There is no significant relationship between age and knowledge of breast self-examination. 2. Research Methodology 2.1. Research Design This study is a cross-sectional non experimental descriptive research survey used to find out the knowledge and practices of breast self-examination among female nursing students in university of Maiduguri. Descriptive survey was chosen because it is effective in seeking the views of people about particular issues that concerns them.

International Journal of Clinical Oncology and Cancer Research 2017; 2(3): 57-64 59 2.2. Target Population The target population of this study was all the female nursing students of the department of nursing science, college of medical science university of Maiduguri. They number 170. 2.3. Sample and Sampling Technique Using Yemen s formula, sample size of one hundred and nineteen (119) respondents were selected from 100 level to 500 level students in the department of nursing science university of Maiduguri using simple random sampling technique after the use of stratified random sampling which ensured that each strata (class level) was represented in the study. 2.4. Instrument for Data Collection Data was collected by means of self-structured questionnaires. The questions were based on the research questions and consists of question divided into three (4) sections namely. Section A: consist of socio demographic information. Section B: the level of respondents knowledge on breast cancer and breast self-examination. Section C: the level of practice of breast self-examination. Section D: factors affecting level of practice of breast self-examination. 2.5. Validity/Reliability of Instrument for Data Collection To ensure the instruments validity, the questionnaire developed was given to the experts who went through it to ensure face and content validity, the calculated validity index was 0.82. To ensure the instrument reliability, questionnaire was pretested in college of medical science university of Maiduguri using 25 questionnaires at one week interval and a reliability coefficient of 0.73 was found using Cronbach s alpha statistics. 2.6. Method of Data Collection 119 self-developed questionnaires were administered to the respondents on one on one basis. The instrument was used to obtain data on the socio-demographic data of the respondents, their level of knowledge, practice of breast selfexamination and factors affecting practice of breast selfexamination. After completion of the questionnaires, they were all collected for analyses. 2.7. Method of Data Analysis From the distributed questionnaire, 109 were properly filled, returned and were used for data analysis. The quantitative data were analyzed using frequency tables, percentages and Chi- square statistic was used to test the hypotheses. Tables were used in data presentations. 2.8. Ethical Consideration A letter of introduction was collected from the department of nursing science which was received and approved by the department in which the study was conducted and the right of the participants was protected by obtaining their informal consent before administration of the questionnaires and also they were assured of strict confidentiality of information obtained. 2.9. Data Analysis and Presentation The demographic data was analyzed using descriptive statistics of frequency and percentages. The hypotheses were tested using chi-square at level of significance 0.05 other variables were analyzed using frequency distribution and percentage. All the data were presented in tables. 3. Data Presentation 3.1. Socio-demographic Data of the Respondents Table 1. Demographic data of Students. Variables Frequency Percentage(%) 15 20 10 9.2 21 25 68 62.4 Age in years 26 30 13 11.9 31 35 7 6.4 36 40 5 4.6 41 and above 6 5.5 Single 82 75.2 Marital status Married 27 24.8 100 8 7.3 200 24 22.0 Level 300 55 50.5 400 15 13.8 500 7 6.4 Religion Christian 42 38.5 Muslim 67 61.5 Yoruba 9 8.3 Hausa 24 22.0 Ethnicity Igbo 17 15.6 Kanuri 18 16.5 Others 41 37.6 Table 1 above shows the demographic data of the female nursing students of the department of nursing science, university of Maiduguri. A total of 109 female nursing students participated in the study. Majority of the age students age were belonged to age group 21-25 years which is 68%, 11.9% belong to age group 26-39 years, 9.2% belong to age group 15-20 years, 6.4% belong to age group 31-35 years of age. The table also shows that about 75% of the students are single while 27% of the students are married. Majority of the student are in 300 level with 50.5%, 22.0% are in 200 level 13.8% are in 400 level 4.3% are in one hundred level while 6.4% are in 500 level.

60 Habu Haruna et al.: Knowledge and Practice of Breast Self-Examination Among Female Nursing Students in University of Maiduguri, Borno State, Nigeria 3.2. Knowledge of Breast Self-Examination Table 2. Knowledge of students about breast self-examination. Variables Category Frequency Percentage(%) Yes 12 11 Any family history of breast cancer No 97 89 Yes 104 95.4 Have you heard about breast cancer No 5 4.6 Yes 56 51.4 Is it common in this environment No 53 48.6 Can it be detected early Total Yes 97 89.0 No 12 11.0 109 100 Can early detection improve chances Yes 101 92.7 No 8 7.3 Have you heard about BSE Yes 104 95.4 No 5 4.6 TV 21 19.3 How did you heard about it Friends 9 8.3 Health professionals 76 69.7 Others 3 2.8 12 17 40 36.7 At what age should BSE be done 18 23 45 41.3 24 and above 24 22.0 Daily 15 13.8 How often should BSE before Weekly 23 21.1 Monthly yearly 57 52.3 14 12.8 In front of the mirror lying on the bed 19 17.4 A and B 12 11.0 How is BSE done 76 69.6 Others 2 1.0 Table 2 shows that majority do not have any history of breast cancer i.e. 86.2% and about 95.4% have heard about breast cancer 51.4% said breast cancer is common in this environment while 34.9% said it is uncommon in this environment. About 89.0 said it can be detected early while 8.3 said it cannot be detected early. 95.4% have heard about breast self-examination while 2.8% have not heard about it while 1.8% are undecided. About 69.7% of the female nursing students heard about breast self-examination from health professionals while 19.5% heard from the television while 8.3% heard from friends and 2.8% heard from other mediums. 41.3% stated that breast self-examination should be done from age 18-23 years while 36.7% stated that breast selfexamination should be done at 12-17 years and 22.0% stated that breast self-examination should be done from the ages years and above. Majority of the students i.e. 52.3% identified that breast self-examination should be done monthly 21.1% stated that BSE should be done weekly, 13.8% said it should be done yearly. One how breast selfexamination should be done, 69.7% said it is done standing in front of the mirror and also lying flat on the bed. 17.4% to said it is done standing in front of the mirror while 11.0% said it is done lying down on the bed while 1.8% identified other means.

International Journal of Clinical Oncology and Cancer Research 2017; 2(3): 57-64 61 3.3. Practice of Breast Self-Examination Table 3. Students practice of breast self-examination. Variables Category Frequency Percentage(%) Yes 83 76.1 Have you ever practice BSE No 26 23.9 Monthly 57 52.3 Quarterly 15 13.8 If yes how often do you perform it Yearly 22 20.2 Can t remember 12 11.0 Others 3 2.7 Total 109 100 At what age did you start performing BSE 12 17 31 28.4 18 23 57 52.3 1 bove 24 21 19.3 In front of the mirror lying down on the bed 37 33.9 What method of BSE do you use when performing BSE A and B 21 19.3 Others 42 38.5 9 8.3 Total 109 100 When was the last time you performed BSE Last month 52 47.7 This month 30 27.5 Last year 21 19.3 Others 6 5.5 On the level of practice of breast self-examination, about 76.1% have practice breast self-examination, 23.9% have never practice breast self-examination and 52.3% practice breast self-examination monthly while 20.2% practice it yearly and 13.8% practice unequally and 11.0 cannot remember. The last time they performed breast selfexamination. On the age perspective 52.3% started practicing BSE at 18-23 years while 28.4% started at the age of 12-17 and 19.3% stated from 24 years and above. On the method of performing BSE 38.5% perform BSE in front of the mirror and lying down on the bed, 33.7% performed it in front of the mirror, 19.3% performed it lying down on the bed and 8.3% use other method, 47.7% said they last time they performed BSE was last month, 27.5% said they performed BSE this month and 19.3% performed it last year and 5.5% cannot remember the last time. 3.4. Factors That Affect the Practice of Breast Self-Examination On the factors affecting/hindering the practice of BSE 36.7% stated forgetfulness, 22.0% said they had no time 16.5% identified they had no skills in performing BSE and 11.0% each said stress and fear of unknown identified their reasons for not practicing BSE. Table 4. Factors affecting breast self-examination. Variables Category Frequency Percentage What are the factors that hinder you from practicing BSE 3.5. Hypotheses Testing Stress 12 11.0 No time 24 22.0 Forgetfulness 40 36.7 Fear of unknown 12 11.0 Lack of skills 18 16.5 Others 3 2.8 The null hypothesis include 1. There is no significant relationship between knowledge and practice of breast self-examination. 2. There is no significant relationship between information and level of practice of breast self-examination. 3. There is no significant relationship between age and knowledge of breast self-examination. Table 5. Null hypothesis there is no significant relationship between knowledge and practice of breast self-examination. Variables practice Total Statistics Remarks Knowledge Yes No FET = 7.244 Yes 81 23 104 DF = 2 No significant relationship No 1 2 3 P = 0.17 between knowledge and Total 83 26 109 practice of BSE Calculated value = 0.139 Degree of freedom = 2 Level of significance = 0.05

62 Habu Haruna et al.: Knowledge and Practice of Breast Self-Examination Among Female Nursing Students in University of Maiduguri, Borno State, Nigeria Since the calculated value is greater than the tabulated value (critical value) then you reject null hypothesis. This implies that there is significant relationship between Knowledge and practice of breast self-examination which means that the more knowledge people have about breast self-examination, the greater the level of practice. Table 6. Null hypothesis 2 there is no significant relationship between information and practice of breast examination. Variables Practice Monthly Quarterly Yearly Can t remember Other Total Statistics Remark TV 15 3 3 3 2 26 Friends 4 0 2 3 0 9 Health professional 39 13 18 8 0 78 Others 2 0 0 0 1 3 Total 60 16 23 14 3 109 P = calculated value = 0.32 DF = degree of freedom = 12 Level of significant = 0.05 FET = 16.59 DF = 12 P = 0.32 There is no significant relationship reject null hypothesis Since the calculated value is greater than the critical value (tabulated value) null hypothesis is rejected. Therefore, there is significant relationship between source of information and practice of breast self-examination. Table 7. Null hypotheses 3. Therefore is no significant relationship between age and knowledge of breast self-examination. Variable Knowledge Statistics Remark Age Yes No Undecided Total 15 20 8 2 3 13 21 25 70 6 3 79 26 30 13 0 0 13 31 35 7 0 0 7 36 40 2 0 0 2 46 50 2 0 0 2 Total 107 6 6 109 Calculated value = 0.158 Degree of freedom = 9 Level of significant = 0.05 FET = 12.40 DF = 9 P = 0.158 No significant relationship between age and knowledge of breast selfexamination null hypothesis rejected. There is no significant relationship between age and knowledge of breast self-examination. Since the calculated value is greater than the critical value null hypothesis is rejected and conclude that there is significant relationship between age and knowledge of breast self-examination. 4. Discussion of Findings A total of 109 female nursing students of the Department of Nursing Science College of Medical Sciences, University of Maiduguri were enrolled for the study. Majority fall between the ages of 21-25 years from 68-8% 11.9% falls within the ages of 26-30 years, 9.2% falls within the age of 15-20 years and 1.8% falls within the age of 36-40 and 46-50 years respectively about 75.2% of the students are single while 27% of them are married. Majority of the students 50.5 are in 300 level, 22% of the students in 200 level, while 13.8% are in 400 level, 7.3% are in 100 level and 6.460 of the students are in 500 level. Knowledge of breast self-examination among the female nursing students The findings of this study as shown in table 2 indicates that 95.4% (104) of the study population heard about breast cancer and also 95.4% (104) of the female nursing students have also heard about breast self-examination which agrees with the previous study conducted in Lagos by Rosemary et al (2011) among female medical students in university of Lagos which showed that 93.7% of them have heard about breast cancer and also 93.7% of the students have also heard about breast self-examination. In another research carried out by Kayode, Akande and Osagbemi (2005) among female secondary school teachers showed that 95% of the respondent have heard about breast self-examination. The major source of the information on the knowledge of breast self-examination was gained through health professional with 69.7% and 19% of the formation was gained through the television, 8.3% was through friends while 2.8% was through other means in contrast, previous studies by Kayode,, Akande and Osagbemi (2005) showed that the common source of information was through the television. And also in contrast to previous studies by Saludeent, Akande and Musa (2009) which showed that 37.1% knew about breast selfexamination through newspapers However, in relation to other previous research findings most of the respondents have knowledge of breast self-examination and also respondents in health related disciplines are more likely to have more knowledge about breast self-examination. Practice of breast self-examination among the female nursing students The findings on table 3 shows that 76.1% of the students

International Journal of Clinical Oncology and Cancer Research 2017; 2(3): 57-64 63 practiced breast self-examination while 23.9% have never practices breast self-examination 52.3% practice it regularly on a monthly basis while, 15% perform it on a quarterly basis 22% perform it on yearly basis and 12% cannot remember the last time they performed breast self-examination. In relation to previous research findings by Gwarzo, Sabitu and Idris (2009) among medical students in Zaria, showed that 57% of the students practiced breast self-examination and 32.1% practice it on a monthly basis, this findings showed that the female students in University of Maiduguri practice breast self-examination regularly, than the previous studies. But in another study by Rosemary et al (2011) showed that 87.5% of the respondent carryout breast self-examination while 26.7% do not perform breast self-examination. This shows that the practice of breast self-examination was acceptable and is encouraging. Factors that affects breast self-examination among the female Nursing students The finding in table 4 shows that 36.7% of the respondent stated that the reasons for not practicing breast selfexamination was forgetfulness, 22.0% showed time constraint as their reason, 16.3% stated lack of skills in performing breast self-examination, 11.0% fear of unknown and 2.8%show other reasons for not performing breast self-examination. In relation to the research findings by Okobia et al (2006) and in India by Karima and Ashraf (2004) showed variation from lack of time 52% lack of self confidence in their ability to perform the technique correctly, fear of possible findings as reason for not practicing BSE. Also, in accordance with the findings by (Ahmed et al, 2015) also identified that some reasons for not practicing breast self-examination was forgetfulness, lack of time and belief that there was is nothing wrong with their breast. 5. Summary The study was conducted on Knowledge and Practice of Breast Self-Examination among female nursing students in university of Maiduguri. And was aimed at determining the knowledge of breast self-examination and the practice of breast self-examination as well as factors that affect the practice of Breast Self-Examination among female nursing students in University of Maiduguri. The study is in nonexperimental descriptive research survey which was aimed at seeking the view of people about the knowledge and practice of breast self-examination. The total population was 109 female nursing students used as sample. The data were obtained and analyzed using frequency tables, percentages and Chi- square statistic was used to test the hypotheses. Tables were used in data presentations. The findings of the research work show that majority of female nursing student have knowledge of breast selfexamination and most of the students practice breast selfexamination. The major factor affecting the level of practice was forgetfulness and lack of time. Some studies agreed with the findings of the study while others contradict with the findings of the study. 6. Conclusion Most of the respondents have adequate knowledge about breast self-examination. The health professional were the major source of information and friends were the least. The practice of breast self-examination is positive. Therefore, if the students have knowledge of breast self-examination they can effectively practice breast self-examination. Recommendation The researcher recommends the following under the subheadings: a. Nurses should place posters on bill boards and strategic locations like antenatal clinics and female ward to create awareness about breast self-examination b. Nurses should improve their teaching skills to teach students and clients about breast self-examination. c. 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